Ramblings of an Emergency Physician in Texas

Navy vs. Army for HPSP; advice solicited

I got this in the mail the other day, and my thoughts follow. However, I can speak only from one side (the correct, Navy side), and solicit other opinions.

I was wondering if I could trouble you for some advice. I am currently a junior at [a terrific] College and pursuing the pre-med route. I’d really like to serve, and I’m trying to decide between Navy and Army, both of which I understand offer the HSP scholarship. I was wondering how your experience was, why you chose Navy, and if you’d recommend it to someone else considering medicine.

Also, it looks like I’ll have to take a year off after graduation since I won’t have all my pre-med requirements completed in time to apply this summer. I was told by a recruitor that you need to have an admissions letter from an accredited medical school before you start. Do you know if there are any other programs I could do during that year, maybe with EMT certification or something along those lines, to help myself out before I would start.

I chose the Navy for the simple reason that they’d talk to me, while the other recruiters heard my MCAT and wouldn’t give me the time of day. So, I didn’t spend a lot of time service-shopping. My experience was that I got a 1st Class Petty Officer who was interested in doing the job, and did it well. (He did tell me, much later, that I’d probably screwed up recruiting stats that year).

Perhaps the rules have changed, but I’m not sure you have to have a "letter in hand" before they’ll start, that sounds like typical military BS for "I don’t want to waste any effort on the chance you won’t get in". My package was completely ready to go the day I got my acceptance letter, and was off the next day, but again I had a motivated PO1 in my corner.

Anything that exposes you to the realities of medicine will no doubt help, be it routinely volunteering in a hospital or completing an EMT course. The best thing you could do is take a real MCAT prep course, because there’s WAY too much stress put on that number, and as you’re in a position where that number matters, you need to maximize it.

Comments

Personally, I prefered the not-mentioned third choice, the USAF, for my HPSP.

I’m also skeptical of the “letter in hand” rule. I waited until I had been admitted to medical school before applying for the HPSP, not because I was told that was how to do it, but because I didn’t know any better. I was later informed I got the very last scholarship that year. My recommendation is to apply as soon as possible because time does matter.

Finally, I second the thought that an experienced medical recruiter is worth their weight in gold.

I chose the USAF mainly because it was the service I was most familiar with as I grew up in an Air Force town and spent high school and most of college working at the Officers’ Club.

More practically, I felt that they offered the best options for someone interested in Family Medicine, both in terms of residency training options as well as later assignments.

In medical school, I had friends in all the various HPSP programs and everyone was happy with their particular choice. The big difference, as I recall, dealt with the 4 six-week active duty stints you had to serve during med school. The Air Force expected you to be fully active duty in an off-campus military rotation during these “tours” (but often allowed you to get away with 4 weeks instead of 6 weeks). Both the Army and Navy let students serve tours without leaving med school for at least a few of their tours.

One last thing the letter writer may want to consider is how often does the service in question call up the doctor into active duty after their internship? This rarely, if ever, happened in the USAF, but I knew a couple of USN doctors who found the rest of their residency delayed for a few years. (I won’t even pretend to speak for the Army.)

I went to exactly one of the four I was ‘required’ to do. My school had a ridiculously long academic year, and the 6 week stints they had set up either started before I was out of school or ended after I was expected back in class. (One summer I had to change towns, and they allowed that was a good enough reason to miss). I was paid for three of them, so I lucked out.

The Navy has been the worst about getting interns straight into residency training, but thay’ve made some statements about changing that. I have no idea if a change is actually happening.

I agree with Scott and GruntDocs statements above. I joined USAF HPSP in 1988 during my first year of medical school for a three year scholarship. At the time they had 3, and I think even two year scholarships. I don’t know about that possibility now.

At the time in the Air Force you had the best chance of doing your residency right after internship in either an Air Force Program or in civilian deferment. Army was next best, and all my buddies in the Navy did mandatory general medical officer tours before they were able to pursue residency.

I last spoke to an Army Health Care recruiter about HPSP 18 months ago, or so. I was in the opposing position of GruntDoc. They love my MCAT scores, but my grades are iffy.

Anyway, it is true, you cannot be offered the HPSP without a letter of acceptance to a school. However, if you are a good candidate, they will make sure your packet is prepared. This way, when you get the letter, you can have everything in front of the scholarship board straight away.

There are some pretty grand differences between the three major branches, but the generalities are all similar. You get to choose your internship, or your location (to an extent) but not both. For the active duty HPSP, you owe 4 years AD time or equal to your length of residency, which ever is greater. If you take the reserve HPSP, you owe two years for each year, or 8 years reserve duty, whichever is greater.

Military residencies offer you many experiences that civilian residencies do not offer. However, there are fewer specialties that you can have a military residency for. You will also be fighting with some very motivated, dedicated, intelligent people for these residencies. To wit, a significant portion of the graduates of service academies go to med school directly after they graduate. Not all of them get scholarships at the schools they get accepted to. Many take the HPSP to tack 4 (or more) years’ service tacked onto their contract. These are very motivated, capable (if not always brilliant) students. They are formidable competition.

It’s a good deal if you can handle the military lifestyle. I question whether I can daily.

Weighing in with another recommendation for Air Force HPSP (as opposed to the other services).

I had my choice and reviewed the options carefully. The Navy was attractive, but as they (in 1990) tended to use many of their docs as GMO’s, who had to later go back for residency I was less than enthusiastic. Later, while on active duty I heard tell of some high-level conferences where the phasing out of the role of GMO was discussed. Any applicant should find out where things stand before going in, understanding that there are no guarantees other than they will be filling a need of their service, whether it meets their own needs or not. That being said, in residency some of our best docs had been Navy GMO’s. They had already faced the abyss. (I just felt I should do it with more training!) The Air Force gives specialty pays to their residency-trained physicians (the other services must also?) which makes things nicer while you are in.

The Air Force used few GMO’s and most members were allowed to complete a residency (IF it was in a specialty in which they had a projected need). My subsequent experience with the Army was tangential (our AF Hospital was their secondary and tertiary medical care source), but I had multiple contacts with motivated and talented service members whom I felt had been permanently injured/disabled by the macho culture of “grin and bear it.” These were infantry folks that kept going through training even while injured because they didn’t want to be separated from their unit, and didn’t want to be perceived as a whiner. Medical discharges were in their future. (Army troops are MOTIVATED.)

All of the services have the same basic HPSP program (mandated by Congress, I believe). The differences come in post-graduate opportunity, service lifestyle and location and service environment. Some of the smartest and nicest docs I’ve worked with were in the Air Force. I have fond memories of many of the enlisted personnel I worked with. Everyone was in there together trying to make do with what we were given.

At one point, many of us were sitting around comparing notes, and decided that if you already know that you are interested in FP/IM/Pediatrics, that FINANCIALLY it makes sense. If you are aimed for a surgical sub-specialty, or medical subspecialty with a high average salary FINANCIALLY it doesn’t. Assessment of other benefits/rewards of professional development, unique experience, public service, etc. are left to the reader. There is an entity called MMSA (Military Medical Student Association) which would give them access to folks who have more recent knowledge of these issues (www.militarymedicine.org).

Your original questioner should also consider the Public Health Service, as they are covered under HPSP as well.

Read every comment you can find before making this decision. As far as the Navy goes, they have not phased out GMOs and you stand a very good chance of becoming one should you accept their contract.

I suggest looking at http://www.studentdoctor.net in the graduate medical education section of the forums section under “military medicine”. There are lots of opinions there.

The delay to training with the GMO service tour(s) is no small thing. You really should come to as full an understanding of what that kind of obligation entails and how it will affect your being able to train in the medical specialty of your choice.

The HPSP program is not particularly competitive at this time. The Navy in particular has been unable to fill as many as half of its contracts in the past year and worse is projected. The SG himself has said the average applicant’s MCAT was at the minimum for acceptance in allopathic schools. In one recent year, there were no applicants accepting contracts from top-tier schools.
That is a significant decline in applicant quality from years past.

I went through the Navy HPSP program several years ago and did the GMO (flight surgeon) tours. I got out and did my residency and fellowship training as a civilian. I have mixed feelings about the way doctors are utilized by the services: they fall badly short on providing adequate residency training and in many places, they use GMOs inappropriately and even abusively.

I agree that you should consider USPHS, as well as the FAP programs, which pay off student loans while you are in residency.

As an addendum, you are almost as likely to be forward deployed with a Marine ground combat unit as a Navy GMO as you are as an Army GMO. Navy and Army GMOS are on the ground as I write, in Afghanistan and Iraq.

I am an active duty Army emergency physician who went to medical school c/o HPSP. My wife is an active duty Air Force emergency physician who went to medical school c/o HPSP. We currently serve as emergency physicians at Landstuhl Regional Medical Center (Landstuhl, Germany). We are fresh out of residency (Class of 2005 – San Antonio Uniformed Services Health Education Consortium at Brooke Army Medical Center and Wilford Hall Medical Center).

A few thoughts on HPSP and the different services…

HPSP
You will owe one year of active duty service for each year of your scholarship or for each year of your military residency – whichever is greater. In other words: if you accept a four year HPSP and do a five year military residency you will owe five years of active duty service AFTER residency. If you accept a four year HPSP and do a three year military residency you will owe four years of active duty service AFTER residency. HPSP recipients who end up in civilian residency programs (i.e. positions that are NOT funded by the military) owe one year of active duty service for each year of their scholarship and will be placed on active duty immediately upon completion of their residency. This is the same for all services…

You cannot be accepted for an HPSP position without first being accepted into medical school. The recruiters may, however, help you complete the packet prior to acceptance. Make sure your recruiter is a health professions recruiter with experience in HPSP. If you feel the recruiter is unable to answer your questions adequately ask for the name and contact information of his or her supervisor. This is about your future. Accept nothing short of excellence in the recruitment process. And get AS MUCH AS POSSIBLE IN WRITING. Ask to see the HPSP contract template in advance. NEVER sign anything without reading it three times beforehand and only if you are absolutely sure that you understand everything. Do NOT let the recruiter rush you. Remember – a recruiter is the military version of a used car salesman. Their job is to close the deal. Get everything in writing.

Do not accept an HPSP scholarship to save money or reduce your future student loan burden. That would be a bad financial move unless you plan on going into FP or pediatrics (where you break your back to make $100 – $150k per year). Do NOT join the military unless you want to serve and unless you have a very good idea of what life will be like as a soldier, airman, or sailor.

A few thoughts on the different services:

ARMY
The US Army has almost done away with the GMO (general medical officer) requirement after residency. The Army recognizes that trained physicians are an advantage over general practitioners. As a result you can expect to proceed straight from internship to residency without having to delay your training one or two years to serve as a GMO. Army residencies are high speed with board certified physicians serving as academic faculty. You will be expected to apply for five Army residency positions (minimum) upon graduation. You will only be allowed to accept a civilian residency position if you fail to match for the five Army spots — and even then you may get selected (i.e. assigned) as an intern in an internship program that failed to fill its ranks. Soldiers who are accepted (willingly or not) to Army internship programs must reapply for Army residency positions the following year unless they were accepted to an internship program that is part of a particular specialty (i.e. EM, Sx, IM, etc…). If the Army intern (or civilian intern that failed to match into the Army programs the first time around) is not accepted into an Army residency program then they may be assigned as a GMO for one or two years until the opportunity to reapply to a residency program presents itself again. So, while the Army is trying to do away with GMO spots there are still quite a few GMO positions out there…

And even after you complete your residency you may get deployed as a GMO – even if you are a board certified emergency physician. My buddy Chris is in Iraq right now serving as a GMO despite the fact that he is almost a board certified EP (he has yet to complete his oral boards).

Army life is not bad. But expect to deploy to far off places (where people want to kill you) for a minimum of one year at a time (usually a little longer than that). Do NOT join the Army unless you want to serve as an Army physician and understand exactly what it means to be an Army physician. The same goes for the Air Force and the Navy…

AIR FORCE
My wife is an active duty Air Force emergency physician. And her experience is very similar to mine.

The Air Force, being a smaller force in general, has fewer GMO spots. You are more likely to serve in the specialty you pursue once you complete residency. Air Force residencies are also high speed but recognize that there are fewer of them available. As a result you may have to do a civilian residency before you come on active duty as an attending.

Air Force deployments are shorter (currently four months but may soon be changed to six months) and their facilities when deployed are usually more comfortable.

But Air Force physicians go to the same awful places as Army physicians. They make the same sacrifices and work just as hard. While we like to make fun of Air Force personnel (“no air conditioning means no air support”) we have nothing but respect for our Air Force colleagues.

NAVY
My wife’s best friend is a Navy OB/GYN. While she was protected from doing a GMO tour (due to her chosen specialty) most Navy docs, from what I have heard, will find themselves serving as GMO’s after internship. And, as Grunt Doc indicated, they have a close relationship with the Marines… And you know what comfortable lives Marines lead… So, put two and two together and take your chances.

The Navy also has excellent docs and training programs. That is the extent of my Navy knowledge…

SUMMARY
Do not join the military without knowing exactly what to expect. Never sign any military contact without reading it three times and understanding EVERY SINGLE WORD it contains. Never trust a recruiter – get it in writing.

Expect to make less money. Expect to be deployed. Expect to have a second full time job in addition to being a physician (i.e. soldier, airman, sailor).

I am proud that I joined the Army. I do not regret my HPSP decision. But the military environment today is much different than what I was told to expect at the time I was commissioned – I was commissioned before September 11, 2001. No one can tell you what to expect anymore. Accept that your life will be uncertain once you accept a commission.

This message is nothing more than my personal opinion. It may contain errors. If so, they are mine and mine alone.

I went through USC med school (private, so not cheap) via the Navy HPSP scholarship, did an internship in the Navy, followed by a tour as a flight surgeon, which I had to do before being able to complete my training as an otolaryngologist.

Joining the Navy was one of the best things I ever did in my life.

I enjoyed my time as a flight surgeon. I learned to fly military aircraft, spent time with the Marines in a war (I was in the first Gulf War with my squadron), and met my wife ultimately because of my being in the Navy. I can’t say being in a war was “fun” or a good thing, but in terms of learning experiences as both a physician and as an American (is it politically correct to be proud of that now?) it was unmatched.

I felt that the quality of post graduate medical education was excellent (ENT at Naval Regional Medical Center, San Diego, otherwise known as “Balboa”). Just be aware that to get to the point of doing residency, you will very likely need an operational tour, and these days, that could mean going to a war zone.